Provider Demographics
NPI:1710193495
Name:CLARK, RALPH BARKLEY (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:BARKLEY
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 S BROADWAY
Mailing Address - Street 2:SUITE 390
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2632
Mailing Address - Country:US
Mailing Address - Phone:303-707-2839
Mailing Address - Fax:303-770-8588
Practice Address - Street 1:7720 S BROADWAY
Practice Address - Street 2:SUITE 390
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2632
Practice Address - Country:US
Practice Address - Phone:303-707-2839
Practice Address - Fax:303-770-8588
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172672084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE89649Medicare UPIN